Individual
MASROOR ALAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 MEDICAL VILLAGE DR, INDEPENDENT ANESTHESIOLOGISTS PSC, EDGEWOOD, KY 41017-3403
(859) 341-7246
(859) 341-7867
Mailing address
20 MEDICAL VILLAGE DR, STE 258, EDGEWOOD, KY 41017-5401
(859) 341-7246
(859) 341-7867
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
36170
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000192691
ANTHEM BLUE SHIELD
—
01
—
000000642262
ANTHEM
—
05
—
0982843
—
OH
01
—
11179782
CAQH
—
05
—
200320150
—
IN
01
—
311585770 1720069388
HEALTHNET
—
01
—
611077369
TAX ID
—
05
—
64028475
—
KY
Enumeration date
11/10/2005
Last updated
02/23/2010
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